The Best Medicine

A letter in response to Atul Gawande’s article (August 13 & 20, 2012)

Atul Gawande’s article comparing restaurant chains to hospital chains focusses on what it is like to eat at the Cheesecake Factory, but overlooks how much more pleasant it often feels to work at a mom-and-pop bistro with a vested interest in the local community (“Big Med,” August 13th & 20th). Many service employees, unfortunately, do not have the choice to forsake fast-food joints for jobs at sole proprietorships, unlike health-care professionals, who often do have a choice. Moreover, the less autonomy and joy that physicians find in their work environments, the less likely they are to bring passion and enthusiasm to their labors. If hospitals become Pizza Huts, many prospective medical students may instead pursue careers in biotech or scientific academia which afford more freedom. Comparisons with fast-food restaurants, air safety, or military organization may offer some insights regarding how to improve health-care delivery, but it is essential to remember that these are merely comparisons, not genuine models. As both a practicing physician and a patient, I do not want my medicine prepared and served one-size-feeds-all, like a beet salad with goat cheese.

Jacob M. Appel, M.D.

Department of Psychiatry

The Mount Sinai Hospital

New York City

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